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Positive attitude, social support may promote TBI/PTSD resilience

Navy Lt. Cmdr. John Derenne, a psychiatrist at Naval Hospital Jacksonville, discusses mental health and resiliency at the hospital’s Behavioral Health Clinic. Derenne, a native of Orange, California, says, “Mental health challenges should not be hidden or ignored; seeking help early is a sign of strength. Just like physical fitness, good mental health is integral to your well-being and mission readiness.” (U.S. Navy photo by Jacob Sippel) Navy Lt. Cmdr. John Derenne, a psychiatrist at Naval Hospital Jacksonville, discusses mental health and resiliency at the hospital’s Behavioral Health Clinic. Derenne, a native of Orange, California, says, “Mental health challenges should not be hidden or ignored; seeking help early is a sign of strength. Just like physical fitness, good mental health is integral to your well-being and mission readiness.” (U.S. Navy photo by Jacob Sippel)

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Posttraumatic Stress Disorder | Traumatic Brain Injury

Untangling the relationship between traumatic brain injury and posttraumatic stress disorder is a complex challenge, one that researchers at the Defense and Veterans Brain Injury Center, the Defense Health Agency’s traumatic brain injury center of excellence, are tackling. They are discovering important insights that may help to reduce symptom severity and increase resilience.

DVBIC researchers found that psychological experiences prior to an injury may play a role in recovery in patients diagnosed with both mild TBI, also known as concussion, and posttraumatic stress disorder. Screening for the effects of past trauma may help health care providers identify and treat individuals at greater risk of developing persistent post-concussion symptoms or PTSD.

“The difficulties an individual experiences may relate to stressors and other symptoms that had occurred even before experiencing a TBI,” explained Dr. Lisa Lu, a clinical neuropsychologist and research scientist at DVBIC.

Combat situations sometimes lead service members to experience both a mild TBI and psychological distress. In order to understand more about how the two conditions relate to each other in specific individuals, researchers asked questions of cause and effect: 

  • Does experiencing a mild TBI make a person more likely to experience PTSD?
  • Does the presence of PTSD symptoms mean that an individual has also experienced a mild TBI?
  • Do life experiences prior to military service affect the likelihood that an individual will or will not experience PTSD, mild TBI, or both?

Data collected since 2005 may help answer these questions. Pioneered by DVBIC neuropsychologist Dr. Jan Kennedy, the San Antonio Prospective Traumatic Brain Injury Clinical Tracking Repository helps TBI researchers collect information on the mental health background of TBI patients. Empirical findings contained in the repository have led to multiple studies on TBI, PTSD, and their relationship.

“You have to be in touch with the needs of the service members and ask the relevant research questions that address those needs,” Kennedy said.

In a 2018 study, researchers identified 165 service members with mild TBI, some of whom also had a diagnosis of PTSD. They considered variables such as “positive attitude” -- what the researchers termed “resilience” -- and past trauma. Researchers concluded that resilience was associated with whether an individual reported symptoms from mild TBI or PTSD. Those with lower resilience scores were more likely to report symptoms associated with mild TBI and/or PTSD.

Social support is also important. In another study, Kennedy, Lu, and their colleagues at the DVBIC location at San Antonio Military Medical Center surveyed 326 service members with mild TBI during primary care visits. They found that the presence of regular social relationships – for example, consistent weekly interactions with friends and family – appeared to protect resilience after the TBI.      

These findings suggest that knowledge of prior experiences and attitudes may be just as important for providers as the therapeutic interventions they prescribe for TBI and PTSD.

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Seizures among Active Component service members, U.S. Armed Forces, 2007 – 2016

Infographic
1/25/2018
This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data •	A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. •	The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) •	There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. •	Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces •	For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. •	Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  •	A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). •	For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. •	Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. •	Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. •	Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR

This infographic documents a retrospective study which estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. The study also evaluated the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD.

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Health Readiness | Posttraumatic Stress Disorder | Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report

Diagnoses of Traumatic Brain Injury Not Clearly Associated with Deployment, Active Component, U.S. Armed Forces, 2001 – 2016

Infographic
4/4/2017
Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force.  TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment). Categorization of person time during surveillance period included four categories: Group 1 (Never deployed/TBI before first-ever deployment), Group 2 (Currently deployed or within 30 days of return), Group 3 (previously deployed but not currently deployed nor within 30 days of return) and Censored after Diagnosis of TBI. From 2001-2016, 276,858 active component service members received first-time diagnoses of TBI. The crude overall incidence rate of TBI among deployed service members was 1.5 times that of service members assigned to Group 1 and 1.2 times that of service members in Group 3 during the surveillance period.  Total TBI cases by group were Group 1 42.8%, Group 2 13.2% and Group 3 44.0%. Incidence rates by group (per 100,000 person-years) were Group 1 1,141.3, Group 2 1,690.5, and Group 3 1,451.2. Learn more at www.Health.mil/MSMR and see fact sheets at www.Health.mil/AFHSB

Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force. TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment).

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Traumatic Brain Injury | Armed Forces Health Surveillance Branch
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